New Report: High Job Satisfaction Among Public Health Nurses, But Many State Health Departments Struggle to Fill Vacancies

New surveys identify compelling need to advance education and training, increase diversity, and improve recruitment of public health nurses.

Princeton, N.J.—Public health nurses play an essential role in improving the population’s health and delivering essential health services to communities, but the public health nursing workforce is facing significant challenges. More than two in five state health departments report having “a great deal of difficulty” hiring nurses and nearly 40 percent of state and local health departments report having insufficient resources to fill vacant nurse positions.

Those are among the findings of a report released today by the Robert Wood Johnson Foundation (RWJF), which provides the first comprehensive assessment of the size, composition, educational background, experience, retirement intention, job function, and job satisfaction of nurses who work for state and local health departments.

Enumeration and Characterization of the Public Health Nurse Workforce: Findings of the 2012 Public Health Nurse Workforce Surveys, produced by the University of Michigan Center of Excellence in Public Health Workforce Studies and funded by RWJF, collected data from state and local public health departments and surveyed public health nurses themselves. It finds that public health nurses report concerns about job stability, compensation, and career growth in light of budget-tightening at many state and local health departments. Yet these nurses also report very high levels of job satisfaction and that they feel they are making a difference in their communities—factors that could bolster recruitment efforts.

“Capturing this data about public health nurses, who represent the largest professional sector of the public health workforce, gives us a clearer picture of the challenges before us,” said Pamela G. Russo, MD, MPH, RWJF senior program officer. “It should be a high priority to address gaps and take steps to strengthen the public health nursing workforce. As health reform is implemented, and as public health agencies are transforming to a more population-health- oriented role in promoting health and protecting communities, public health nurses will need additional training to keep pace with the changes. The size, makeup, and preparation of the public health nursing workforce greatly affect the ability of agencies to protect and improve the health of people in their jurisdictions.”

The new report offers a snapshot of the current public health nurse workforce—estimated at 34,521 full-time equivalent RNs—and highlights the need for ongoing systematic monitoring in order to: inform competency, compliance and credentialing efforts; permit better alignment of academic resources with workforce needs; and allow for better understanding of the relationship between workforce infrastructure and population health outcomes. Among its findings:

Nearly two in five respondents to the survey (39%) report that their highest nursing degree is a diploma/associate’s degree. Just 10 states require public health nurses to have BSN degrees.

Providing clinical services is part of the work done by RNs in state and local health departments, but these nurses assume a wide variety of roles, including health promotion, disease surveillance, community health assessment, policy development, and more.

The public health nursing workforce does not reflect the diversity of the communities it serves. Just 4 percent of public health nurses self-identify as Hispanic/Latino and 95 percent of those in leadership positions self-identify as White.

The public health nurse workforce is aging; however, most RNs do not intend to retire within the next five years.

Recruitment and hiring of RNs into public health nurses positions can be challenging, particularly for state health departments.

Lack of promotion opportunities is a concern to both health departments and RNs.

Public health nurses report extremely high levels of job satisfaction, despite reporting high levels of dissatisfaction with salaries.

Recommendations in the report, created by the project’s advisory committee, include:

Develop feasible opportunities for additional education and training for public health nurses.

Improve the pipeline and intensify recruitment so public health nurses in health departments reflect the racial and ethnic composition of the communities they serve.

Determine how changes in the functions of public health departments, due to health care reform and the transformation of public health agencies’ work, may affect the education public health nurses need.

Conduct follow-up studies to monitor size, composition, capacity and functions of the public health nurse workforce over time, to help ensure this workforce is well-prepared to meet emerging needs.

“The nation depends on a strong public health nursing workforce, and these surveys identify clear challenges that federal, state, and local policy-makers, health agencies, and academic and philanthropic leaders can address,” said Matthew L. Boulton, MD, MPH, director of the Center of Excellence in Public Health Workforce Studies and associate professor at the University of Michigan School of Public Health (UMSPH).

“We shouldn’t overlook the importance of positive findings related to job satisfaction,” added Angela J. Beck, PhD, MPH, the Center’s associate director and research assistant professor at UMSPH. “With 85 percent of public health nurses reporting job satisfaction and 90 percent reporting that they feel they make a difference in the health of their communities, we have a strong foundation to build on.”

Several earlier national studies have attempted to count public health nurses in specific settings, but until now there has been little data collected on the characteristics of the public health nursing workforce as a whole. This limitation has made it difficult to determine the most strategic and sustainable approaches to providing training that will increase the skills and impact of this essential workforce. For this report, RWJF commissioned both organizational- and individual-level public health nurse workforce surveys, conducted by the University of Michigan Center of Excellence in Public Health Workforce Studies, to address these gaps in knowledge.

A public health nursing research agenda, established in 2010 by a collaborative working group of leaders in public health nursing, emphasized developing a better understanding of how metrics related to public health nursing impact population health. The Enumeration and Characterization of the Public Health Nurse Workforce report, released today,provides baseline data that can further this research agenda.

About the Robert Wood Johnson Foundation

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to health and health care, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, measurable, and timely change. For more than 40 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. Follow the Foundation on Twitter at www.rwjf.org/twitter or Facebook at www.rwjf.org/facebook.